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Effect of balloon-expandable and self-expanding stent fixation on endoluminal polytetrafluoroethylene graft healing
M P Ombrellaro1, S L Stevens, J Sciarrotta
1Department of Surgery, University of Tennessee Medical Center, Knoxville 37920, USA.
Purpose:
To investigate the effect of stent design and deployment mechanism on endoluminal graft healing.
Method:
Twenty dogs underwent infrarenal abdominal aorta polytetrafluoroethylene (PTFE) interposition (6) or intraluminal stented grafting using either a balloon expandable (BE, n = 8) or self-expanding (SE, n = 6) stent design. Grafts were removed at 8 weeks. Length of endothelial ingrowth and intima to media height ratios (IMHR) were calculated. Perianastomotic smooth muscle (Actin+), macrophage (CD44+), proliferating (PCNA+), and platelet-derived growth factor (PDGF+) cell content were determined.
Results:
Mean endothelial ingrowth was 1.10 +/- 0.15 cm (control), 1.88 +/- 0.13 cm (BESG), and 2.16 +/- 0.18 cm (SESG) proximally; and 0.94 +/- 0.12, 2.11 +/- 0.11 cm, and 2.16 +/- 0.15 cm, respectively, at the distal anastomosis. Endothelial ingrowth was greater in all stented grafts (P <0.001). Mean IMHRs were 1.42 +/- 0.16 (control), 0.50 +/- 0.14 (BESG), and 0.77 +/- 0.2 (SESG) proximally; and 0.84 +/- 0.1, 0.42 +/- 0.09, and 0.77 +/- 0.12 (SESG) distally. Lower IMHRs were observed in all stented graft regions (P <0.05) except the distal anastomosis of SESG. The PDGF+ and PCNA+ cell content was decreased, and Actin+ cell content was increased in all stented grafts (P <0.05).
Conclusion:
Intraluminal location enhances endothelialization and attenuates intimal thickening in PTFE grafts. The enhanced healing of intraluminal stented grafts is irrespective of the type of stent or deployment mechanism used.